Anxiety. It’s a word not many of us have a good relationship with. If you’re stuck in an anxiety loop, there’s good news, you can unlearn it! Author Judson Brewer, MD, PhD teaches us how to do just that in his new book, Unwinding Anxiety: New Science Shows How to Break the Cycles of Worry and Fear to Heal Your Mind.
Read an excerpt from Unwinding Anxiety below.
A Brief Word On Mindfulness
Here again is Jon Kabat-Zinn’s definition of mindfulness:
[Mindfulness is] the awareness that arises through paying attention in the present moment, on purpose, nonjudgmentally.
If you recall, our old brain reacts to positive and negative reinforcement to determine what to do, and then is good at turning that behavior into habits. Most of this happens subconsciously. If we aren’t aware that we’re doing something habitually, we will continue to do it habitually. (That’s the autopilot part that we talked about in chapter 2.)
But we can become more aware of these habit patterns in action. That’s what mindfulness helps us do: build awareness so that we can observe our caveman brains in action.
People often get confused about how mindfulness relates to meditation, whether they are the same or different. A simple way to visualize this is by employing a Venn diagram in which mindfulness is a big circle and meditation is the smaller circle within it.
In other words, meditation falls within the category of ways to train mindfulness. You don’t need to meditate to be mindful, yet meditation helps you become more and more aware of what’s happen- ing right now. Meditation is like a gym for your brain, allowing you to build and strengthen your mindfulness muscles.
Awareness also helps you pay attention to triggers and automatic reactions. This goes for much more than anxiety and worry habit loops; in fact, it applies to anything that we’re reacting to. But a word of warning: there is a lot of misinformation out there which argues that mindfulness is a special (non-anxious) state of mind, or merely a relaxation technique. I see this in my clinic patients a lot: the more they try to clear their mind of anxious thoughts or think their way out of anxiety, the more anxious they become. The most common misperception is summed up by a question I often get asked when I am teaching at retreats or when I’m introducing my patients to the idea of mindfulness: “How do I rid my mind of my thoughts?” This erroneously suggests that the goal of meditation is to “empty the mind.”
Good luck with that—I tried that for ten years, sweating through t-shirts in the middle of winter on long silent meditation retreats, and it didn’t work. Besides, I also spent the majority of medical school and residency training trying to stuff my brain full of as much information as possible. Why would I want to empty it?
Mindfulness is not about stopping, emptying, or ridding our- selves of anything. Thoughts, emotions, and physical sensations are what make us human. And thinking and planning are both crucial things to master. If I wasn’t able to use my thinking brain to take a clear clinical history and make a solid diagnosis, I would have one heck of a time providing good care for my patients.
so rather than changing or not having the thoughts and feelings that make up our experience, mindfulness is about changing our relationship to those thoughts and emotions.
But this isn’t an easy thing to do. In fact, a 2010 Harvard study showed that we get caught up in thinking (mind-wandering, to be exact) for about 50 percent of our waking lives. That’s a lot of time running on autopilot.
Because this state of mind is so common, it can be measured in the brain. There is even a network of regions called the default mode network (DMN). The DMN was discovered by Marcus raichle and his crew at Washington University in st. louis. It was called the default mode network because this is what our minds go to whenever they are not engaged in a specific task.
The DMN gets activated when our mind is wandering, thinking about things in the past or future, caught in repetitive thought patterns such as rumination, anxiety, or in other strong emotional states, and when we’re craving various substances. And for better or worse, we default to thoughts and memories about things that are related to us. We regret things that we’ve done in the past, worry about events coming up in the future, and so on.
A hub of the DMN called the posterior cingulate cortex (PCC) connects a bunch of other brain regions together. The PCC is interesting because it gets activated when people are shown pictures that are reminders of or triggers for their addictions. For example, the PCC lights up with cocaine cues (e.g., a picture of a few lines of cocaine on a mirror) in cocaine-addicted individuals, with smoking cues (e.g., a picture of someone smoking) in nicotine-addicted individuals, and with gambling cues (e.g., a picture of someone playing roulette) in individuals addicted to gambling. Basically, the PCC gets all fired up when we get caught up in craving and other types of perseverative thinking habit loops like rumination (focusing on one’s distress and repeatedly thinking about it over and over), which is a hallmark of depression and anxious worry. Perseveration simply means thinking the same thing over and over; worry is the poster child for this. to make sure this concept is clear, I’ll give you some examples:
Craving Habit Loop
trigger: see cake
Behavior: eat cake
result: Feel good
Rumination Habit Loop
trigger: Feel low in energy
Behavior: Think about how down you feel, how you will never get anything done, etc.
result: Feel (more) depressed
Anxious Worry Habit Loop
trigger: look at unfinished to-do list
Behavior: Worry about not getting it done
result: Feel anxious
As a side note, depressed individuals seem to be so good at perseverative thinking habit loops that two-thirds of them also meet the psychiatric diagnostic criteria for anxiety disorders. This commonality between depression and anxiety is an example of perseverative thinking habit loops that are basically out of control—they feed on themselves. Why is that? Well, a research study by Yael Millgram and her colleagues at the Hebrew University suggested that the familiarity of a mood state contributes to our staying in it. When we are sad or anxious all the time, that sadness or anxiety becomes familiar, a place that we gravitate toward, something like a morning routine or a regular route to work. Any deviation feels unfamiliar, perhaps scary or even anxiety-provoking. From a survival standpoint, this makes sense: if we are traveling in unknown territory, we have to be on guard because we don’t know yet if it is safe or not. Don’t forget, not all habits are bad. They become bad only when they are tripping us up or slowing us down instead of helping us move forward.
We can become so identified with mental habit loops that they become our identity, who we think we are. In fact, an early pilot tester of my Unwinding Anxiety program wrote me the following email:
Is there any difference between how one would approach unwinding “I am having an anxious thought” vs “I am anxious?” . . . I am learning to use the techniques well enough to work with reflexive type episodes— anxiety arising from a busy day, stress of a missed deadline, an upcoming event . . . what I’m struggling with is the kind of anxiety that comes from who I perceive myself to be and the seemingly impermeable blanket of not-good-enough-ness that it is wrapped in. Deep etched in the bones anxiety.
From UNWINDING ANXIETY by Dr. Judson Brewer, published by Avery, an imprint of Penguin Publishing Group, a division of Penguin Random House, LLC. Copyright © 2021 Judson Brewer